[Targeted use of comprehensive geriatric assessment tools in cardiology. Part I (literature review).]

The purpose of this review is to demonstrate the importance of using a comprehensive geriatric examination in cardiology, including geriatric aspects of the management of this patient population. Until now, the Russian Federation has completely lacked a geriatric approach to the management of cardiological patients, which provides for consideration of international experience in this survey. The curation of elderly and elderly patients is complicated by the presence of geriatric syndromes and age-associated diseases leading to deterioration of quality of life, repeated hospitalizations, disability and risk of death. The leading geriatric syndrome in geriatric practice is senile asthenia and multiple comorbid polymorbid pathologies of the geriatric patient. A patient admitted to an acute care hospital with a history of cardiovascular comorbid pathology is primarily viewed as a patient at high risk for cardiovascular complications, omitting the risk of adverse outcomes, including loss of independence and impaired functional status. The following literature review demonstrates the importance of defining senile asthenia outside of the geriatrician's office, justifying the need for advanced training for cardiologists in geriatrics.

[The assessment of the efficacy of Ethoxidol treatment in patients with chronic cerebral ischemia]. / Otsenka effektivnosti primeneniya preparata Etoksidol u patsientov s khronicheskoi ishemiei mozga.

OBJECTIVE: To evaluate the clinical effects of ethylmethylhydroxypyridine malate (Ethoxidol) in patients with chronic cerebral ischemia in an outpatient practice. MATERIAL AND METHODS: 60 patients were examined, 58 patients with a diagnosis of cerebrovascular disease (chronic cerebral ischemia) completed the participation in the program. The average age of the patients is 61.2±8.2 years. Neurological complaints typical of patients with chronic cerebral ischemia were recorded. To assess the dynamics of neurological disorders during therapy were used: The Montreal Cognitive Assessment (MoCA), Multidimensional fatigue inventory (MFI-20), Berg Balance Scale (BBS), Tinnitus Handicap Inventory (THI), Clinical Global Impression of Improvement Scale (CGI). The doctors and the patients satisfaction with therapy was assessed using the Visual Analogue Scale (VAS); quality of life - by the VAS of the European Quality of Life Group (EQ-VAS). The course of therapy lasted 60 days. All patients received daily Ethoxidol chewable tablets 400 mg/day (2 tablets (200 mg) in the morning and 2 tablets (200 mg) in the evening). RESULTS: The results of the observational program showed high efficacy and good tolerability of Ethoxidol in patients with chronic cerebral ischemia. A statistically significant decrease in the severity of the clinical manifestations of chronic cerebral ischemia was noted as early as the 30th day of therapy, followed by maintaining a positive trend until the end of the course of treatment with the drug (60th day). On the therapy, the severity of asthenia, cognitive impairment, dizziness, balance disorders, and tinnitus decreased. There was a decrease in the severity of the condition and the presence of clinical improvement on the CGI scale; there was an increase in the quality of life of patients on the EQ-VAS scale. The majority of the patients and the doctors rated the therapy as effective and safe and were satisfied with it. No serious adverse events were reported. CONCLUSION: The data obtained allow us to consider Ethoxidol as an effective drug in the treatment of patients with chronic cerebral ischemia in an outpatient practice.

Declines in Strength and Mortality Risk Among Older Mexican Americans: Joint Modeling of Survival and Longitudinal Data.

BACKGROUND: Grip strength is a noninvasive method of risk stratification; however, the association between changes in strength and mortality is unknown. The purposes of this study were to examine the association between grip strength and mortality among older Mexican Americans and to determine the ability of changes in strength to predict mortality. METHODS: Longitudinal data were included from 3,050 participants in the Hispanic Established Population for the Epidemiological Study of the Elderly. Strength was assessed using a hand-held dynamometer and normalized to body mass. Conditional inference tree analyses were used to identify sex- and age-specific weakness thresholds, and the Kaplan-Meier estimator was used to determine survival estimates across various strata. We also evaluated survival with traditional Cox proportional hazard regression for baseline strength, as well as with joint modeling of survival and longitudinal strength change trajectories. RESULTS: Survival estimates were lower among women who were weak at baseline for only 65- to 74-year-olds (11.93 vs 16.69 years). Survival estimates were also lower among men who were weak at baseline for only ≥75-year-olds (5.80 vs 7.39 years). Lower strength at baseline (per 0.1 decrement) was significantly associated with mortality (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.01-1.19) for women only. There was a strong independent, longitudinal association between strength decline and early mortality, such that each 0.10 decrease in strength, within participants over time, resulted in a HR of 1.12 (95% CI: 1.00-1.25) for women and a HR of 1.15 (95% CI: 1.04-1.28) for men. CONCLUSIONS: Longitudinal declines in strength are significantly associated with all-cause mortality in older Mexican Americans.

Contribution of Therapeutic Monitoring in the Assessment of Toxic Adverse Effects of Mitotane: a Case Report.

Mitotane provided serious side effects and low doses seemed to be tolerated. Determination of mitotane concentration in plasma is recommended. We report the case of toxic plasma levels with low doses of mitotane in a 47-year-old man with adrenocortical cancer.

[Efficacy, safety and cost of eribulin in patients with metastatic breast cancer]. / Efficacité, tolérance et coût de l'éribuline chez des patientes présentant un cancer du sein métastatique.

Eribulin gained its approval in March 2011 for the treatment of patients with locally advanced or metastatic breast cancer (MBC) whose disease has progressed despite anthracycline and taxane-containing regimens. This study retrospectively assessed the efficacy, safety and cost of this treatment for all patients with MBC treated by eribulin in Franche-Comté. Ninety-four patients received eribulin between July 2006 and October 2013. The median age was 62 years (35-83). Median overall survival was 10.3 months [95% CI: 7.6 to 17.9]. Median progression-free-survival was 3.8 months [95% CI: 2.9 to 5.0]. Clinical benefit was obtained in 55% evaluable patients [95% CI: 43.1 to 66.9] by RECIST criteria. Most common grade 3-4 adverse events (AEs) were neutropenia (38%), asthenia (10%) and peripheral neuropathy (7%). Median cost of the treatment was 9767 € per patient (6344-17,517). This analysis found similar results to the EMBRACE study despite less selected population. A medico-economic evaluation cost-utility type would assess the effectiveness of this strategy compared to standard treatments.

Autoimagem corporal de pacientes comcâncer gastrointestinal / Body image of patients with gastrointestinal cancer

Introdução: O câncer é uma enfermidade multicausal caracterizadapelo crescimento descontrolado, invasivo e rápido de célulasem que há mutação genética. As alterações corporais como a perdade cabelo, presença de cicatrizes, astenia e amputação de membros,além dos tratamentos instituídos, podem acometer indivíduos comneoplasias malignas, provocando alterações corpóreas permanentese acarretando comprometimento da autoimagem corporal.Objetivo: Investigar, na literatura, se existe alteração na avaliaçãoda autoimagem corporal em pacientes com câncer gastrointestinal.Métodos: Trata-se revisão da literatura utilizando-se artigos indexadosem Medline/Pubmed, Lilacs/Bireme e SciELO, com ênfasenos últimos dez anos (2004-2014), nos idiomas, português, inglês eespanhol, além de capítulos de livros científicos.Resultados: Estudos demonstram que as alterações metabólicas eimunológicas provocadas pelo tumor, assim como as condições clínicas,nutricionais e alterações gastrointestinais podem interferirno estado nutricional e alterar o prognóstico da doença. É demonstradotambém que pacientes oncológicos podem ser acometidospor alterações corporais que acarretam comprometimento severoda autoimagem corporal, podendo afetar a qualidade de vida e percepçãocorporal. A avaliação da imagem corporal por meio de escalasde silhuetas e de escalas contendo questionários estruturados érecomendada. Observa-se que a literatura apresenta o interesse peloestudo da interferência entre a presença de estomias com a imagemcorporal de pacientes com câncer gastrointestinal.Conclusão: Verificou-se maior prevalência de insatisfação corporalentre os pacientes que apresentam alterações corporais em decorrênciado câncer. Porém, são necessários novos estudos paraavaliar os reais efeitos do câncer e terapias antineoplásicas sobre aimagem corporal desses pacientes.(AU)

Introduction: Cancer is a multifactorial disease characterizedby growth uncontrolled, invasive and fast of cells in which thereis genetic mutation. The bodily changes such as loss of hair, presenceof scars, asthenia and amputation of limbs, in addition toestablished treatments, can affect individuals with malignancies,causing permanent bodily changes and resulting impairment ofbody self-image. The bodily changes such as loss of hair, presenceof scars, asthenia and amputation of limbs, in addition to establishedtreatments, can affect individuals with malignancies, causingpermanent changes in the body, resulting in impairment of bodyself-image.Objective: To investigate, in the literature, if there is change in theassessment of body self-image in patients with gastrointestinalcancer.Methods: This is a literature review using indexed articles in Medline/ Pubmed, Lilacs / Bireme and SciELO, emphasizing the lastten years (2004-2014), in Portuguese, English and Spanish, as wellas scientific book chapters.Results: Studies have shown that metabolic and immunologicalchanges caused by the tumor, as well as the clinical conditions, nutritionaland gastrointestinal disorders can interfere with nutritionalstatus and change the prognosis of the disease. It is also shownthat these patients may be affected by bodily changes that causesevere impairment of body self-image, which can affect the qualityof life and body awareness. The assessment of body image throughsilhouettes and scales containing structured questionnaires is recommended.It is observed that literature contains mostly interestin the study of interference between the presences of ostomy bodyimage of patients with gastrointestinal cancer.Conclusion: It was found a higher prevalence of body dissatisfactionamong patients with bodily changes from cancer, but furtherstudies are needed to assess the actual effects of cancer and anticancertherapies on body image of these patients.(AU)

Access to disease treatment among patients presenting to the emergency department with asthma or hypertension.

BACKGROUND: Asthma and hypertension are common among Emergency Department (ED) patients. Primary care providers are integral in managing these conditions, yet these patients are often in the ED. OBJECTIVE: To determine access to care among ED patients with asthma or hypertension and the association with sociodemographic factors and disease acuity. METHODS: This was a prospective, cross-sectional study of ED patients at an urban county hospital conducted between June 4 and August 31, 2008. Consenting patients were surveyed, and peak flow or blood pressure measured as appropriate. Access to disease treatment was defined as self-reported access to a primary care provider or current prescription for asthma or hypertension, or both. Descriptive statistics and multinomial logistic regression were used to analyze data. RESULTS: There were 2303 patients enrolled; 283 had asthma, 543 had hypertension, and 187 had both. Seventy-one patients (25.1%) with asthma, 151 patients (27.8%) with hypertension, and 19 patients (10.2%) with both had poor access to disease treatment. Seeking ED medical attention was related to having poor access to treatment for patients with both asthma and hypertension. Females with asthma had poor access to treatment. In hypertension patients, good access to treatment was associated with excellent/good health status, housing status, and decreasing age. Poor access to treatment was associated with increasing blood pressure. CONCLUSIONS: Poor access to disease treatment and aspects of socioeconomic status were associated with seeking care in the ED. Changes in access to treatment may affect the number of patients seeking ED care, but not the severity of the presenting illness.

Asthma disparities and within-group differences in a national, probability sample of same-sex partnered adults.

OBJECTIVES: We examined the prevalence and correlates of self-reported lifetime diagnosis of asthma and current asthma among same-sex and opposite-sex partnered adults. METHODS: Data were from the 2004 Behavioral Risk Factor Surveillance System, in which same-sex partnership was a response option to a family planning item in the core questionnaire. Self-reported lifetime diagnosis of asthma and current asthma were examined in logistic regression models adjusted for demographic characteristics and asthma-related confounding factors and stratified by both gender and same-sex partnership status. RESULTS: Significantly higher proportions of same-sex partnered male and female respondents reported lifetime and current asthma compared with their opposite-sex partnered peers. In adjusted analyses, same-sex partnership status remained significantly associated with asthma outcomes among men and women, with odds ratios ranging from 1.57 to 2.34. CONCLUSIONS: Results corroborated past studies that indicated asthma disproportionately affects sexual minority populations. The addition of sexual minority status questions to federal survey projects is key to further exploring health disparities in this population. Future studies are needed to investigate the etiology of this disparity.

Geomedicine: area-based socioeconomic measures for assessing risk of hospital reutilization among children admitted for asthma.

OBJECTIVES: We assessed whether geographic information available at the time of asthma admission predicts time to reutilization (readmission or emergency department revisit). METHODS: For a prospective cohort of children hospitalized with asthma in 2008 and 2009 in Cincinnati, Ohio, we constructed a geographic social risk index from geocoded home addresses linked to census tract extreme poverty and high school graduation rates and median home values. We examined geographic risk associations with reutilization and caregiver report of hardship. RESULTS: Thirty-nine percent of patients reutilized within 12 months. Compared with those in the lowest geographic risk stratum, those at medium and high risk had 1.3 (95% confidence interval [CI] = 0.9, 1.9) and 1.8 (95% CI = 1.4, 2.4) the risk of reutilization, respectively. Caregivers of children at highest geographic risk were 5 times as likely to report more than 2 financial hardships (P < .001) and 3 times as likely to report psychological distress (P = .001). CONCLUSIONS: A geographic social risk index may help identify asthmatic children likely to return to the hospital. Targeting social risk assessments and interventions through geographic information may help to improve outcomes and reduce disparities.

Astenia en pacientes que asisten a la consulta externa: valoración a través de la escala de intensidad de fatiga (FSS) / Asthenia in patients attending the outpatient clinic: valuation through the rating scale fatigue

Muchos pacientes acuden a consulta externa con un conjunto inespecífico de síntomas y signos que sugieren el diagnóstico de astenia, sin encontrarse una causa orgánica que explique dichos síntomas. Se realizó un estudio prospectivo a nivel nacional para diagnosticar y cuantificar la intensidad de la astenia en estos pacientes y medir la eficacia de la sulbutiamina 400 mg/día como tratamiento farmacológicoa corto plazo de primera línea. Se realizó un estudio abierto, prospectivo y multicéntrico,en el cual se ingresaron 341 pacientes, que consultaron ambulatoriamente y que presentaban síntomas de astenia. A través de la escala de Intensidad de Fatiga (por sus siglas en inglés: Fatigue Severity Scale - FSS) se determinó la presencia de astenia en estos pacientes y se evaluó la eficacia de la sulbutiamina 400 mg/día de Laboratorios Leti S.A.V., Venezuela (Tekron®). El estudio tuvo una duración de 15 días, en los cuales el paciente fue evaluado tres veces: día 1 (inicio), día 7 y día 15. Si el paciente presentaba astenia (puntuación ≥ 36 puntos en la FSS), se le indicaba sulbutiamina400 mg/día con el desayuno por 15 días. El 74,7% de los pacientes evaluados fueron del sexo femenino, con una edad media de 43,7 ± 12,5 años y el 25,3% del sexo masculino con una edad media de 41,7 ± 13,5 años. Al inicio del estudio la media de la puntuación de la FSS fue de 49,7 ± 7,3 puntos; a los 7 días de tratamiento con 400 mg/día de sulbutiamina fue de 37,2 ± 8,8 puntos con una disminucióndel 25,2% y al día 15 fue de 28,0 ± 9,8 puntos con una disminución de 43,7% con respecto al inicio del tratamiento, resultando estadísticamente significativo (p< 0,0001 y p< 0,0001 al día 7 y día 15 vs inicio, respectivamente). El 77,7% de los pacientes respondieron al tratamiento al día 15. La sulbutiamina resultó ser un tratamiento muy bien tolerado, se reportaron eventos adversos leves en 132 pacientes (38,7%) al día 7 y en 115 pacientes(33,7%) al día 15...

Many patients attending out patient clinics with a set of nonspecific symptoms and signs that suggest the diagnosis asthenia, without organic cause to explain the symptoms. In order to determine which of was these patients confirmed the diagnosis of functional asthenia, was performed a prospective nation wide, study to diagnose and quantify the intensity of fatigue in these patients and measure the effectiveness of sulbutiamine 400 mg/day treatment short-term drug frontline. Was realized an open, prospective, multicenter study, which entered 341 outpatient patients which showed signs of fati gue. The Fatigue Severity Scale (FSS) was used as a tool for the diagnosis and evaluation of severity of fatigue and was evaluated the effectiveness of sulbutiamine 400 mg/day to Leti Laboratories, S.A.V. (Tekron®), as first line treatment.The duration of the study was 15 days, with 3 evaluations (day 1 or baseline, day 7 and day 15). The score of the FSS had to be ≥ 36 points to be enrolled. 74,7% of patients were females with a mean age of 43,7 ± 12,5 years old and 25,3% were males with a mean age of 41,7 ± 13,5 years old. At baseline, the FSS score was 49,7 ± 7,3 points; at day 7 was 37,2 ± 8,8 points with a decrease of 25,2% and at day 15 was 28,0 ± 9,8 points, with a decrease of 43,7% respective to baseline, being statistically significant (p< 0,0001 and p< 0,0001 at day 7 and day 15, respectively). The percentage of response to treatment was 77,7% at day 15. Sulbutiamine was a very well tolerated treatment, there were reported mild adverse events in 132 patients (38,7%) at day 7 and in 115 patients (33,7%) at day 15. Sulbutiamine 400 mg/day is a secure treatment, it is well tolerated and effective in improving the asthenia symptoms, as demonstrated in this clinical trial by the significant decrease in the FSS mean score and the percentage of patients with asthenia at day 15 of treatment

Chronic non-communicable diseases in Brazil: burden and current challenges.

Non-communicable diseases (NCDs) have become a major health priority in Brazil--72% of all deaths were attributable to NCDs in 2007. They are also the main source of disease burden, with neuropsychiatric disorders being the single largest contributor. Morbidity and mortality due to NCDs are greatest in the poor population. Although the crude NCD mortality increased 5% between 1996 and 2007, age-standardised mortality declined by 20%. Declines were primarily for cardiovascular and chronic respiratory diseases, in association with the successful implementation of health policies that lead to decreases in smoking and the expansion of access to primary health care. Of note, however, the prevalence of diabetes and hypertension is rising in parallel with that of excess weight; these increases are associated with unfavourable changes of diet and physical activity. Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year. However, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies, especially those of a legislative and regulatory nature and those providing cost-effective chronic care for individuals affected by NCDs.

Assessment of growth performance, immune responses, serum metabolites, and prevalence of leg weakness in broiler chicks submitted to early-age water restriction.

The objective of this study was to evaluate the effects of two methods of early-age water restriction on performance, some immune responses, serum metabolites, and prevalence of leg weakness in broiler chicks. One-hundred-eighty-seven-day-old chicks (Ross 308) were allocated to three treatments with four replicates based on a completely randomized design. Treatments included the control group, where birds had free access to water, and water-restricted groups, where access to water was limited to three 2-h periods (WRT1) or a 12-h period (WRT2) per day from days 7 to 17. Chicks in the control group were significantly heavier (P < 0.05) at 17 and 46 days of age compared to the restricted birds. In the WRT2 group, feed intake decreased significantly over the 17- to 28-day period while feed conversion ratio was poorer during water restriction (P < 0.05). Antibody titers against Newcastle and SRBC were higher (P < 0.05) for chicks with ad libitum access to water. Birds in the restricted groups exhibited a higher heterophil to lymphocyte ratio compared to the control group (P < 0.05). The treatments had no significant impact on serum metabolites including protein, triglyceride, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterols, calcium, and phosphorus concentrations. Walking ability, tibial dyschondroplasia, foot pad, hock burn, and valgus/varus angulation were not significantly influenced by water restriction. In conclusion, the current results indicate that early-age water restriction negatively influenced productive traits and immunological responses of broiler chicks and failed to have any favorable impacts on leg health.

Mometasone furoate versus beclomethasone dipropionate: effectiveness in patients with mild asthma.

OBJECTIVES: To evaluate adherence to therapy and markers of asthma control among patients with mild asthma prescribed mometasone furoate dry powder inhaler or beclomethasone dipropionate hydrofluoroalkane aerosol inhaler. STUDY DESIGN: Retrospective healthcare claims database analysis (2005-2008). METHODS: Included were patients with mild asthma aged 12 to 65 years (1273 matched patients in each treatment cohort) who resided in the United States and were enrolled in their health plan for at least 1 year before (ie, preindex period) and after (ie, postindex period) they initiated treatment with mometasone furoate or beclomethasone dipropionate. Patients were propensity score matched based on demographic data and preindex variables. Claims were analyzed during the postindex period for adherence to mometasone furoate or beclomethasone dipropionate, measured as the percentage of days covered and the numbers of exacerbations and short-acting beta2-agonist (SABA) claims. RESULTS: Multivariate analyses indicated that the cohort receiving mometasone furoate had better outcomes than the cohort receiving beclomethansone dipropionate, including greater adherence (29.5% vs 20.2%, respectively, P <.001), fewer exacerbations (mean, 0.12 vs 0.19, P = .002), and decreased SABA canister claims (mean, 0.9 vs 1.1, respectively, P <.001). CONCLUSIONS: Adherence to prescribed therapy among patients with mild asthma may be better with mometasone furoate versus beclomethasone dipropionate, as reflected in fewer exacerbations and more limited use of SABA rescue medications. Improved adherence to mometasone furoate versus beclomethasone dipropionate may be related to a simpler dosing regimen (ie, once daily vs twice daily).

Complications of multiple myeloma therapy, part 1: risk reduction and management of peripheral neuropathy and asthenia.

Peripheral neuropathy (PN) and asthenia (fatigue) occur as both disease- and treatment-related complications in patients with multiple myeloma (MM). Risk factors for treatment-related PN, which has an estimated incidence of 37% to 83% among patients with MM, include therapy duration, dose intensity, cumulative dose, and the presence of preexisting neuropathy. Asthenia is the most common adverse effect of treatment, occurring in approximately 76% to 96% of patients receiving therapy. The severity of PN and asthenia can range from mild to potentially debilitating. These conditions can be dose limiting; they may interfere with optimizing duration of therapy and may also substantially affect patient quality of life. Regular screening and monitoring, combined with patient education and effective management strategies, can reduce the risk of these treatment-related complications, as well as their consequences.

[Screening for hereditary HFE hemochromatosis]. / Dépistage de l'hémochromatose génétique HFE.

Screening for hereditary HFE hemochromatosis in the general population, by either phenotype or genotype, is not currently recommended by the French High Health Authority. Targeted screening for hereditary HFE hemochromatosis in groups with specific diseases (people with asthenia, arthropathic disorders, liver or heart disease, etc.) has not been shown to be effective. Family screening in first-degree relatives of any proband homozygous for C282Y is strongly advised. This should involve both phenotypic screening, that is, testing for serum iron markers and, if possible, a genotype study of siblings and adult children, conducted according to the rules for genetic counseling and testing. This type of screening is cost-effective. One obstacle today is that the national health insurance fund does not reimburse the HFE test.

Assessment of tumor necrosis factor alpha blockade as an intervention to improve tolerability of dose-intensive chemotherapy in cancer patients.

PURPOSE: Maintaining dose-intensity with chemotherapeutic agents is hindered by a number of adverse effects including asthenia/fatigue. Tumor necrosis factor (TNF) is one of the cytokines responsible for the fatigue and cachexia associated with malignancies. We used etanercept (TNF-decoy receptor) to maintain dose-intensity of weekly docetaxel. PATIENTS AND METHODS: Initially, 12 patients with advanced malignancies were randomly assigned to either docetaxel 43 mg/m2 weekly alone (cohort A) or the same docetaxel dose plus etanercept 25 mg subcutaneously twice weekly (cohort B). Subsequently, higher doses of docetaxel in combination with etanercept were evaluated. Pharmacokinetics (PKs), nuclear factor-kappa B (NF-kappaB) activation, and intracellular cytokines levels were measured. Patients completed weekly questionnaires quantifying asthenia/fatigue. RESULTS: Twenty-nine of 36 intended docetaxel doses during the first cycle were delivered in cohort A, and 35 of 36 doses were delivered in cohort B (P = .055). Three cohort B patients received additional cycles in the absence of disease progression or severe toxicity, whereas no patients from cohort A received additional cycles. Escalation to docetaxel 52 mg/m2 weekly with etanercept resulted in neutropenia, not fatigue, as the limiting adverse effect, and the addition of filgrastim permitted the maintenance of dose-intensity in additional patients. Patients randomly selected to receive etanercept/docetaxel self-reported less fatigue (P < .001), and docetaxel PKs show no relevant influence of etanercept. NF-kappaB activation and increased expression of TNF-alpha were associated with increments in docetaxel dose. Antitumor activity was noticed exclusively in patients receiving etanercept. CONCLUSION: The addition of etanercept is safe and had no impact on docetaxel concentrations. The significant improvement in tolerability and the trend toward preservation of dose-intensity suggests further exploration of TNF blockade as an adjunct to cancer therapies.

Psychoneurophysiological assessment of recovery of cognitive function in patients with asthenia during rehabilitation.

Forty patients with severe asthenia were subjected to clinical, neurological, psychometric, and neurophysiologic examination before and after Enerion therapy. Psychoneurophysiological assessment with cognitive evoked potentials P300 and psychometric tests revealed serious impairment of cognitive functions in patients before therapy (compared to healthy individuals). Enerion therapy decreased the degree of psychoautonomic syndrome and asthenia and improved cognitive functions.

Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis.

OBJECTIVES: To investigate whether the single-item fatigue question of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Multidimensional Fatigue Inventory (MFI) are appropriate instruments to measure fatigue in ankylosing spondylitis (AS); to identify factors that influence fatigue in AS; and to assess how fatigue in all its aspects is associated with quality of life in AS. METHODS: A total of 812 patients with AS were included. Patients completed questionnaires on disease activity (BASDAI), functional ability (Bath Ankylosing Spondylitis Functional Index [BASFI]), global well-being (Bath Ankylosing Spondylitis Global Score [BAS-G]), overall perceived health (EuroQoL visual analog scale), and quality of life (Ankylosing Spondylitis Quality of Life questionnaire, and Short Form 36 [SF-36]). Patients were dichotomized into a F+ group (fatigue = major symptom) if the BASDAI fatigue score was > 5.0 and a F- group (fatigue = minor symptom) if the fatigue score was < 5.0. Reproducibility was assessed with intraclass correlation coefficients, and responsiveness was calculated according to 3 different methods. Logistic regression analysis was used to determine which factors were associated with fatigue. Multiple regression analysis was used to investigate whether fatigue contributes in explaining quality of life. RESULTS: Fifty-three percent of the patients were assigned to the F+ group. They scored significantly worse compared with the F- group with respect to each dimension of the MFI and to all other questionnaires studied (all P < 0.001). The BASDAI fatigue question, as well as each separate dimension of the MFI, showed moderate to good reproducibility (0.57-0.75) and responsiveness (0.23-0.96). Fatigue was, in the opinion of the patients, highly associated with pain (70% of patients) and stiffness (54% of patients). Logistic regression analysis showed that scores on BASDAI, BASFI, BAS-G, and mental health status (SF-36) were independently associated with fatigue (R(2) = 0.52). Multiple regression analysis showed that scores on the BASDAI fatigue question were significantly associated with quality of life. With the 5 MFI dimensions as explanatory variables, different aspects of fatigue were associated with different domains of quality of life. CONCLUSIONS: Fatigue as a major symptom of AS can effectively be measured with either a single-item question on the intensity of fatigue or with the MFI. The MFI, however, provides more insight into specific dimensions of fatigue. Fatigue appears to be associated with the level of disease activity, functional ability, global well-being, and mental health status. In addition, fatigue negatively influences different aspects of quality of life.